Final Report > Chapter 4: The Changing NHS 1984 - 1995 > The NHS and developments in the care of children

The NHS and developments in the care of children

39 We refer here to developments in healthcare services for children which are relevant to an understanding of what took place in Bristol. There were not only technical and scientific advances. These were accompanied by an increasing awareness of the separate and particular needs of children as patients. There was a growing recognition in the 1980s and 1990s of the need to see children not as small adults, but as a group of patients with distinct physiological and psychological needs.

40 Professor David Baum, President of the Royal College of Paediatrics and Child Health 1996-1999, told us that caring for children's needs: `might be very different from an adult approach to fluids, to electrolytes, to drugs, taking into account their position in the family, the health care of the parents, other siblings, educational need. ... social setting and so on.' [15]

41 An increasing emphasis was placed upon the facilities and environment in which acute healthcare services for children should be delivered. In 1991, for example, the DoH issued guidance: `The Welfare of Children and Young People in Hospital'. [16] It stressed the need to ensure that care in hospital was child- and family-centred. One consequence was that more attention was given to providing child-friendly facilities, to providing accommodation for parents when visiting children in hospital, to involving parents in the care of their child, and to providing a range of advice, information and support for them.

42 The institutional arrangements for supporting and promoting the education and training of healthcare professionals in paediatric care developed significantly from the 1970s onwards. The Association of Paediatric Anaesthetists was set up in 1973, the Paediatric Intensive Care Society in 1987, and the British Cardiology Association in 1991. The Royal College of Paediatrics and Child Health received its charter as a Royal College in 1996.

43 But, progress in achieving improvements in acute healthcare services for children was slow. Two particular problems were evident throughout the 1980s and the 1990s. First, there were insufficient numbers of paediatrically trained staff (nurses and doctors) to provide a fully paediatric service. Secondly, there was a national shortage of Registered Sick Children's Nurses (RSCN) during the late 1980s and early 1990s. There were only two RSCNs working at the BRI in the early 1990s in the Wards (5A and 5B) where very sick children undergoing open-heart surgery were cared for. [17]

44 There was also a national shortage of paediatric intensive care nurses, which was reflected in Bristol. The Intensive Care Society reached the view by the early 1990s, that it was essential that a senior nurse with several years of experience of paediatric intensive care be in charge of the nursing care in the Unit. They also advised that a minimum of one trained nurse to one patient should usually be required for a
24-hour period. [18]

45 This meant that the bedside establishment should be 6.4 whole-time equivalents (WTE) per patient per 24 hours, a ratio endorsed by the Paediatric Intensive Care Society. [19] The staffing level at the BRI was 5.4 WTE. This reflected the mix of adults and children.

46 There was also a national shortage of paediatric cardiologists. In the late 1980s, the British Cardiac Society and the Royal College of Physicians of London regarded this shortage as `very worrying'. [20] This national shortage was starkly reflected in Bristol. For the early part of the period of our Terms of Reference there were only two senior paediatric cardiologists. A third was appointed in 1989. There were no trainees who could support them. They bore an extremely heavy workload involving not only their patients in Bristol but the need to visit `outreach' clinics throughout the South West and South Wales.

47 There was no specialist paediatric cardiac surgeon in Bristol. The two cardiac surgeons who operated on children also operated on adults.

Footnotes

[15] T18 p.46 Professor Baum

[16] HOME 0002 0001; DoH `The Welfare of Children and Young People in Hospital', HMSO, 1991

[17] WIT 0114 0012 and T32 p.76 Fiona Thomas

[18] T32 p.41 Fiona Thomas

[19] T7 p.152 Dr Ratcliffe

[20] BPCA 0001 0001